Provider Demographics
NPI:1598383077
Name:RICE, AUTUMN JOY (PNP-AC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JOY
Last Name:RICE
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:JOY
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2551 GROVER HARDEE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9154
Mailing Address - Country:US
Mailing Address - Phone:419-799-0382
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-8432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013306363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care